根據美國公共衛生學會（the American Public Health Association, APHA）于2004年11月在華盛頓召開的第132次年會的最新報告指出：美國的衛生事業在經歷多年的穩步上升之后，出現了下降趨勢的跡象，這樣不久之后也許會將美國的衛生事業引向錯誤的方向。

   根據該報告，“美國的衛生狀況：各州的衛生排行榜”，揭示了三個重要不良趨勢：四十年來嬰兒死亡率首次升高，所有年齡組人群的肥胖流行率增加，在2003年～2004年有38個州的無保險人數增加。

   APHA執行主任Georges Benjamin醫學博士告訴Medscape網站，那篇報告發現90年代衛生事業得到了改善，大約以每年1.5％的速度最終增加了17.5％，但最令人不安的是，這種趨勢現在也許發生了逆轉。從新世紀開始，衛生增長只有微不足道的0.2％，這個結果敲響了警鐘。

  Benjamin醫學博士評論：“盡管我們國家的健康狀況在過去15年中取得了長足進步...，我們發現增長速度的戲劇性下降并不令人鼓舞。”他特別指出，嬰兒死亡率從每千人6.9增加到7.0，這個統計數據將美國的嬰兒死亡率置于世界第28位，同時還發現有14個州早產率超過13％。與這個具有警示作用的統計數據相關的是：1,260萬美國處于生育年齡的婦女沒有保險。

   Benjamin醫學博士說：“顯而易見，國家必須重視這種相關性。引起早產有多種因素，比如：貧窮、懷孕期間缺乏精心照顧、以及感染。但是對治療這些婦女的臨床醫生而言，這【早產比例的增加】是醫療保健體系處于危險狀態一個明證?！?/P>

   Benjamin醫學博士號召臨床醫師參加到有組織的醫學活動中，以敦促政策制訂者意識到當前存在的問題，以及嬰兒死亡率、早產率的增加在未來十年中可能給經濟和衛生事業帶來的負面作用。

   Benjamin醫學博士說：“不用多久就可以知道你選舉出的政府官員，也不需要很多時間來參與，但是我們知道醫生的參與可以影響政策的走向。”由APHA、聯合健康基金會（United Health Foundation)、預防互助協會（Partnership for Prevention）共同作出的報告敲響的另一個警鐘是：在1990～2003年期間肥胖人數快速增加了97％。

   聯合健康基金會的副會長Reed Tuckson醫學博士說：“為了成功地戰勝肥胖的流行，我們必須動員我們的社區資源，并制定有效的公共政策。”他還補充說肥胖者大約占美國人口的22.8％，僅過去一年肥胖率就上升了3.2％。

   但是報告也著重指出，去年有幾項積極的發展可以促進衛生事業的發展。這包括每人花費在公共健康活動上的支出增加了17％，吸煙率下降了4％，心血管疾病的死亡率下降了2％。在絕大多數州傳染性疾病的發病率也有所下降。

    高中畢業率出現微小的增加，從67.3％上升到了68.3％。Benjamin醫學博士指出，考慮到教育與對健康問題認識之間的聯系，這個發現是“令人鼓舞的”。年度報告權衡了18個與總體健康有關的指標，包括吸煙率、早產死亡、高中畢業率和人均公共衛生消費，從而描繪出各州健康狀況的構成圖。在各州排名中，路易斯安那州作為最不健康的州已長期居于榜首，緊隨其后的是田納西州和密西西比州。排名居健康榜首的是明尼蘇達州、新罕布什爾州和佛蒙特州。

   Benjamin醫學博士說各州之間總體健康的巨大差異，與貧困水平和未接受保險患者的數量密切相關，兩者共同形成了對公共衛生工作人員和醫療提供者的一個持久挑戰。例如，在美國俄勒岡州貧困兒童的數量在過去10年中由12.4％上升到20.1％，而同期在密西西比州則下降了13％。

   APHA第132次年會新聞發布會。

 Infant Mortality, Obesity Increasing in U.S.

 — After years of steady progress toward improved health in the U.S., there are signs of a
downturn that may soon translate into movement in the wrong direction, according to a new report

   released here at the 132nd annual meeting of the American Public Health Association (APHA).
The report, "America's Health State: State Health Rankings," uncovers three key troubling trends: the first rise in infant mortality rates in four decades, the rapidly increasing prevalence of obesity in all age groups, and the number of uninsured individuals, which increased in 38 states between 2003 and 2004.

   Most disturbing perhaps is the big-picture finding that the health improvements of the 1990s,
during which overall health improved at an annual rate of 1.5% for a total gain of 17.5%, is
headed for reversal. Since the start of the millennium, health improvement has been a negligible 0.2%, a finding that should set off alarms, APHA Executive Director Georges Benjamin, MD, told Medscape.

  "Despite the significant improvement in our nation's health over the last 15 years..., the trends we're seeing now — especially this dramatic slowdown in the rate of improvement — are not encouraging," Dr. Benjamin said.

   In particular, he cited the increase in infant mortality from 6.9 to 7.0 births per 1,000, a
statistic that puts the U.S. 28th internationally in infant mortality, as well as the finding
that 14 states have preterm birth rates that exceed 13%. That alarming statistic is likely
associated with the fact that 12.6 million American women of child-bearing age are uninsured.
"Clearly, there is a connection there that cannot be ignored, and this is something we must
address as a nation," Dr. Benjamin said. "Prematurity has many factors, from poverty to
inadequate prenatal care and infections, but for the clinicians who treat these women, this
[increasing prevalence of preterm births] is clear evidence of a healthcare system in crisis," he said.

   Dr. Benjamin urged physicians to get involved in organized medicine activities directed toward increasing policy-makers' awareness of both the current problems and the consequences that high infant mortality and poor preterm birth statistics herald — economically and in health status — for the decade ahead.

   "It really doesn't take long to get to know your elected officials, and it doesn't take a lot of time to get involved — and we know that physician involvement can make a difference" in how policy is shaped, Dr. Benjamin said.

   Another alarming finding of the report, jointly produced by the APHA, United Health Foundation, and Partnership for Prevention, was the meteoric rise in obesity, which increased by 97% between 1990 and 2003.

   "To successfully combat this [obesity] epidemic, we must mobilize our community resources and develop effective public policies," said Reed Tuckson, MD, vice president for United Health
Foundation, adding that an estimated 22.8% of the U.S. population is obese and that the obesity
rate rose 3.2% in the last year alone.

  However, the report highlights several positive developments in the last year that have the
potential to yield overall health improvement. These include the 17% increase in per-capita
spending on public health activities, a 4% decrease in smoking prevalence, and a 2% decrease in
deaths from cardiovascular disease. Incidence of infectious disease also declined in most states.

  There was also a slight upward tick in high school graduation rates, from 67.3% to 68.3%, a
finding that Dr. Benjamin called "somewhat encouraging," given the known association between
education and health issues awareness.

  The great disparities in overall health among the states, which correlates closely with poverty levels and the number of uninsured  patients, combines to present a persistent challenge for public health workers and physician providers, Dr. Benjamin said. In Oregon, for example, the percentage of children in poverty increased from 12.4% to 20.1% during the past decade compared with a 13% decrease in child poverty in Mississippi.

   APHA 132nd Annual Meeting: News conference. Presented Nov. 9, 2004.